Combating Covid-19 and economic recovery: Blockchain is the Answer!

Patrick Duvaut and Cristina Belizna

 May 29, 2020

China, South Korea, Israel, Singapore, Taiwan, and Germany are implementing so-called ‘Covid-19 patient-tracking’ applications to accompany the end of lockdown for people across the world, the idea being to save the economy without there being a negative impact on individual or public health. This has spawned debate on the relevant procedures (coercive or otherwise) and technology (privacy-friendly or otherwise), particularly in the light of GDPR.

Triggered by nothing more than a few smartphone features, these discussions implicitly touch on much broader issues underlying the new economic, societal, and healthcare models set to power the post-coronavirus recovery – and indeed life in the Covid-19 era. No study has yet demonstrated that the virus will ever be fully eradicated, however much we may hope for such an outcome. Either way, nothing will ever be the same again.

Indeed, the resumption of economic activity prior to the advent of any Covid-19 vaccine – some 18 months away, according to experts – with all the related protective measures, including “informed, accompanied mobility” (a more acceptable turn of phrase than the more intrusive-sounding “mobility surveillance”) raises fundamental questions focusing on the issues of SHARING and TRUST.

Patients are being asked to trust the systems being set up to collect their health and other personal data. These are needed to track the virus rather than its carriers, but this distinction does not come across in the rather vague announcements, even when these are made with the best of intentions.

Clinical physicians and researchers also need to be able to trust that they can share all available information about the virus, relevant therapies, clinical testing results, vaccines, medication, and so on, in order to combat the pandemic as effectively as possible at a global level. For their part, governments need to be able to trust their citizens, albeit in a rather different way: to apply protective measures above and beyond those that can be legally enforced – practices such as regular hand-washing and social distancing.

Ever since the advent of digital technology, social media, and service platforms, their operators have clearly failed to operate on the “by design” principle when it comes to trust engines that can be authenticated and are transparent, simple, and user-controllable. A large number of scandals involving leaks and the sale of personal data to digital marketing monopolies (cf. Cambridge Analytica, Zoom, etc.) genuinely evidences trust failures. These critical questions arising from the alienation brought about by digital technology are nothing new, but they are becoming all the more acute with the coronavirus – especially if the answers are wrong or come too late, thereby resulting in the deaths of the most vulnerable. Time has run out, we no longer have the choice; we need to find effective solutions, fast.

The challenge resides in the difficulty, amid Covid-19, of reconciling two major social goals: public and individual health on the one hand, and civil liberties on the other – and to do so as regards both privacy and control of the mobility and interaction that are vital to economic recovery.

Indeed, there is a divide between biological life and economic activity. Prior to the onslaught of Covid-19, the triumph of greed and the ensuing excessive use of fossil fuels suffocated the planet and set many lifeforms on the road to extinction. What Covid-19 has revealed is that complete lockdown – deprivation of freedom of movement – allows the spread of virus to be mitigated (but not treated), but at the cost of bringing the economy to a complete halt. Meanwhile, countries that hesitated to impose a lockdown for the sake of the economy are now paying a heavy human price in the pandemic.

To achieve these twin goals in an age of coronavirus, there are three potential sources of leverage: medical (the preserve of doctors), behavioural (the purview of citizens), and governance (in the hands of states).

There are two types of medical leverage. On the one hand, a number of preventive measures play a key role in the new patient journey, known as health democracy. Protecting people’s state of health at home, by means of various connected clothes, watches, wristbands, and similar wearable devices, together with other remote medical data collection systems. Quick, reliable, user-friendly screening tests (similar to basic pregnancy tests). Vaccines that could help us keep one-step ahead of mutations of the virus. On the other hand, there are curative resources: drugs and treatments that mitigate the impact of contamination and related infections, such as hydroxychloroquine, plasma transfusion from recovered patients loaded with antibodies, oxygenation, intubation for the most serious cases, and so on.

Billions of individuals have now adopted positive behavioural levers with access to running water, soap, and hand sanitizer (none of which are widely available in Africa). These include frequent hand-washing, social distancing, working from home whenever possible, wearing a mask, and venturing outside as infrequently as possible, in strict compliance with states’ legal restrictions.

Governance levers are presently solely in the hands of national governments; the latter are all acting independently of each other, despite the inherently global nature of trade, social relations, and the pandemic itself.

Almost without exception, all countries have implemented lockdown in a centralised, coercive manner, even in democracies such as France, where being outside the home without due grounds incurs fines or even imprisonment in the event of multiple offences.

Significant differences are appearing between various plans for economic recovery: ending lockdown, partially ending lockdown, or indeed “alternating lockdown”, a solution recently suggested by Israeli researchers.

China, South Korea, and Israel have achieved some degree of effectiveness by accompanying their lockdowns with the coercive, intrusive, centralised tracking of individuals, including access to identified geolocation data, even facial recognition technology in some cases.

Singapore has taken an intrusive, centralised, but incentive-based approach, encouraging its residents to use a Bluetooth-based application, based on the collection of geolocation data matched to smartphone owners’ identities: this alerts them if they have encountered an infected user.

This type of practice is clearly unacceptable in EU countries, where GDPR compliance and ethical considerations require technology to track the spread of the virus by potential carriers to be anonymous and indeed on an opt-in basis only. From this, it follows that while the procedures expected in Europe are the purview of centralised government (i.e. states) they are incentive-based and non-intrusive. In practice, the ideal system would comprise the following stages: massive deployment of effective, user-friendly TESTS (such as PAOTScan), and anonymized TRACKING of the spread of the virus (e.g. using NODLE.io) in both space and time, for people on the move.

The post-lockdown governance and tracking measures recommended by EU Member States, rightly viewed as advocates of privacy (and thus the authors of GDPR), therefore turn out to be somewhat limited.

These limitations are of several kinds.

The coronavirus does not stop at borders, so to be effective in combating it, measures must be international and marshal all sources of leverage, including anonymized tracking of infection pathways. Centralised governance that is the sole preserve of states is not enough; furthermore, it is overly dependent on local political regimes, which may discriminate against certain categories of the population and adopt tracking solutions that are incompatible with those in neighbouring countries, resulting in people being confined within their borders. These major limitations constitute arguments in favour of decentralised governance to accompany the lifting of lockdown required for economic recovery, based around international organisations such as the WHO, the UN, the IMF, and the European Commission, as fully Trusted Third Parties.

The most advanced, anonymized Covid-19 proximity tracking technologies currently available on smartphones, using Bluetooth protocols and preserving privacy, do not resolve the issue of separating geolocation from the IP address and therefore the identity of the user. As a result, even with secret-key encryption, they cannot be used to send important data relating to the trajectory of the virus in space and time – data that could be used to improve knowledge of the virus propagation mechanisms and patterns – not even just to doctors and researchers, solely for research purposes and for the public good.

What is more, clinicians need secure access to other information about the state of health of individuals and patients. Medical doctors need to anticipate the appearance of symptoms, including the slight symptoms characteristic of the first phases of infection, and during post-discharge convalescence; such data would be particularly useful to relieve the load on hospitals, fine-tune the tracking-diagnosis-therapy cycle, and keep the numbers of serious cases as low as possible.

The ethical traceability solutions currently being envisaged in Europe are therefore inadequate as regards information SHARING with clinicians and researchers; and there is no solution for secure, remote TRACKING that is TRUSTED, de-centralised from end-to-end, and GDPR-compliant.

Behavioural levers will play a key role in post-lockdown strategies to support economic recovery during the Covid-19 era. If, as European Commissioner for Internal Market Thierry Breton has given to understand, intrusive and coercive approaches are to be rejected, only incentive-based approaches remain. The Commissioner is asking for volunteers! Even if the issues for those leaving lockdown are literally a matter of life and death, the profound sources of individual motivation described by David C. McClelland reveal that a voluntary basis is not enough.

Indeed, together with specialists in neuroscience, this twentieth-century US psychologist tells us that our inmost sources of motivation to adopt behaviours, especially restrictive behaviours, are fourfold: the need for affiliation (SHARING), the quest for wellbeing and a retreat from stress and pain (NUDGE), a sense of being a hero for a great cause (survival of the species in the face of Covid-19, the establishment of a new social contract), and lastly having some form of control and understanding of the impact of our behaviour – otherwise known in this digital age as empowerment.

To be incentivised, citizens engaging in “accompanied, informed mobility” need to be given the ability to control and measure what they SHARE as they contribute to the common good. Over and above a “Covid-19 passport” – a one-off, purely administrative document held by the passive subject of a State recording whether or not they have tested positive – this would entail providing citizens with a form of “Covid-19 Cockpit”. Covid-19 Cockpit is a TRUSTED dashboard that could serve as an interactive, personal scoreboard and coach in good post-lockdown behaviour, over which citizens would have full control.

Surprisingly enough, a solution fulfilling the ambitious aim of overcoming the limitations of existing ethical, non-intrusive ways of facilitating economic recovery in the Covid-19 era could be deployed in a matter of weeks.

This solution is CySHARE, an international & secured platform for the TRUSTED SHARING of all the information needed by clinicians and researchers over the world to combat the Covid-19 pandemic on all preventive and curative fronts – together.

CyShare is an open international and anonymized plateform for blood donors for plasma: convalescent plasmas (from people who healed from Covid 19) and immunoglobulins. These two therapeutic options are the safest and more efficient based on actual medical data as therapeutic arsenal in Covid 19.

Swift collaboration between international partners seeking to map their Covid-19 patient data would make it possible to advance together in the battle against an invisible enemy: FAST, RELIABLY, and protecting each individual’s PRIVACY.

Connected to the Covid-19 Cockpit of all consenting citizens, who remain the sole arbiters when it comes to consulting their data, the platform enables specialists to have secret-key access, subject to certification of their status, to “Covid-19 patient cycle trajectories” available in the Covid-19 Cockpit, for the common good: WEARABLE TELE MEDECINE (via medical data-gathering technology located as closely as possible to individuals’ bodies, at home, and more especially in hospitals) – screening TESTS – ACCOMPANIED & INFORMED MOBILITY (anonymized, ethical, distributed-governance tracking) or ISOLATION – PRESCRIPTION/THERAPY (blood and plasma donors, offering treatments as soon as they are available, etc.) – WEARABLE TELE MEDECINE, etc.

In addition to the Covid-19 trajectory, the Covid-19 Cockpit contains state certification of individuals’ infection status and a log of how well they are following behavioural guidelines, all under users’ sole control, so that they can view and measure their own progress, as well as the quality and impact of their personal contributions on the health of the community as a whole.

CySHARE comprises two series of modular engines that can be connected to existing applications. Firstly, highly secure SHARING engines for telepresence, video, audio, chat, and co-edition tools. And secondly, TRUST engines, activated by a next-generation blockchain: fast, frugal, scalable, low-cost, user-friendly, user-controllable, and publicly auditable through recourse to international Trusted Third Parties such as WHO, IMF, UN, the EC, etc.

The blockchain ensures the following levels of TRUST: decentralised, international governance; end-to-end anonymisation of patient data SHARED with clinical practitioners, solely for preventive and curative research; the integrity and security of the Covid-19 Cockpit and its control by the user; the notarisation and state certification of the user’s state of health; date-stamping and notarisation of Covid-19 ‘proximity events’ during the course of accompanied, informed mobility; the notarised coaching of quality and progress in the adoption of behavioural levers, with the help of AI; and the possibility of ‘tokens’ as an automatic reward for behaviours that contribute to the common good.

The success of measures to support economic recovery in a Covid-19 age rely on our ability to make SHARING and TRUST the foundations of a new social contract and of new models for the economy, healthcare, and governance.

CySHARE is supported by an international collective comprising some fifty clinical physicians and researchers from a variety of disciplines working in university hospitals and health research bodies in France, Italy, Spain, Argentina, Austria, Russia, Israel, and Canada, with a range of relevant key specialities for combating Covid-19: immunology, infectiology, virology, epidemiology, autoimmune diseases, pharmacy, and more.